31P NMR spectroscopy detects metabolic abnormalities in asymptomatic patients with hypertrophic cardiomyopathy

BACKGROUND

Hypertrophic cardiomyopathy (HCM) often causes sudden, unexpected death in adolescents and young adults. Alterations in myocardial metabolism are considered to be causes for contractile dysfunction. We examined the question of whether metabolic abnormalities antedate the manifestation of symptoms in patients with HCM.

METHODS AND RESULTS

Proton-decoupled 31P NMR spectroscopy of the anterior left ventricular wall of the heart of 14 young, asymptomatic patients with HCM was performed with a 1.5-T whole-body imager. Spectra of the phosphate metabolites were compared with those of normal control subjects. The patients exhibited a significantly reduced (P<0.02) ratio of phosphocreatine (PCr) to ATP of 1.98+/-0.37 (mean+/-SD), compared with 2.46+/-0.53 obtained in 11 normal control subjects. In addition, the group of patients with severe hypertrophy of the interventricular septum (n=8) showed a significantly increased (P<0.05) Pi-to-PCr ratio, with a Pi x 100/PCr of 20.0+/-8.3 versus 9.7+/-7.2 in control subjects. Both abnormalities are similar to those found in ischemic myocardium. This view is also supported by a significantly increased (P<0.01) phosphomonoester (PME)-to-PCr ratio, with a PME x 100/PCr of 20.7+/-11.2 compared with 8.4+/-6.7 in control subjects, indicating altered glucose metabolism.

CONCLUSIONS

31P NMR spectroscopy detects alterations of myocardial metabolism in asymptomatic patients with HCM. These alterations may contribute to the understanding of the pathophysiology and natural history of the disease.

The backbone dynamics of the amyloid precursor protein transmembrane helix provides a rationale for the sequential cleavage mechanism of γ-secretase

The etiology of Alzheimer's disease depends on the relative abundance of different amyloid-β (Aβ) peptide species. These peptides are produced by sequential proteolytic cleavage within the transmembrane helix of the 99 residue C-terminal fragment of the amyloid precursor protein (C99) by the intramembrane protease γ-secretase. Intramembrane proteolysis is thought to require local unfolding of the substrate helix, which has been proposed to be cleaved as a homodimer. Here, we investigated the backbone dynamics of the substrate helix. Amide exchange experiments of monomeric recombinant C99 and of synthetic transmembrane domain peptides reveal that the N-terminal Gly-rich homodimerization domain exchanges much faster than the C-terminal cleavage region. MD simulations corroborate the differential backbone dynamics, indicate a bending motion at a diglycine motif connecting dimerization and cleavage regions, and detect significantly different H-bond stabilities at the initial cleavage sites. Our results are consistent with the following hypotheses about cleavage of the substrate: First, the GlyGly hinge may precisely position the substrate within γ-secretase such that its catalytic center must start proteolysis at the known initial cleavage sites. Second, the ratio of cleavage products formed by subsequent sequential proteolysis could be influenced by differential extents of solvation and by the stabilities of H-bonds at alternate initial sites. Third, the flexibility of the Gly-rich domain may facilitate substrate movement within the enzyme during sequential proteolysis. Fourth, dimerization may affect substrate processing by decreasing the dynamics of the dimerization region and by increasing that of the C-terminal part of the cleavage region.

Proton-decoupled myocardial 31P NMR spectroscopy reveals decreased PCr/Pi in patients with severe hypertrophic cardiomyopathy

Disturbed myocardial energy metabolism may occur in patients with primary hypertrophic cardiomyopathy (HCM). A noninvasive way to gain insight into cardiac energy metabolism is provided by in vivo 31P nuclear magnetic resonance (NMR) spectroscopy. 31P NMR spectroscopy with proton decoupling was performed in 13 patients aged 13-36 years with HCM on a 1.5 T Magnetom with a double resonant surface coil. A 2D chemical shift imaging (CSI) sequence in combination with slice selective excitation was used to acquire spectra of the anteroseptal region of the left ventricle (volume element: 38 mL). The chemical shifts of the phosphorus metabolites, intracellular pHi, and coupling constants J(alphabeta) and J(gammabeta) were calculated. Peak areas of 2,3-diphosphoglycerate (DPG), Pi, and adenosine triphosphate (ATP) were determined and corrected for blood contamination, saturation, and differences in nuclear Overhauser enhancements (NOE). The maximum thickness of the interventricular septum (IVSmax) was determined from tomographic long-axis images and expressed as number of standard deviations above the mean of the normal population (Z score). The patients were then divided into 2 groups: 6 patients with moderate HCM (HCMm, Z score < or = 5) and 7 patients with severe HCM (HCMs, Z score > 5). No differences between both groups and a control group of healthy volunteers (n = 16) were found with respect to phosphocreatine (PCr)/gamma-ATP ratio, pHi, or the coupling constants. Only the PCr/Pi ratio differed significantly from the control group (HCM(all), alpha < 0.05, HCMs, alpha < 0.02, 2-sided U test). The decrease of the PCr/Pi ratio in patients with HCM is probably caused by ischemically decreased oxygen supply in the severely hypertrophied myocardium.

31P transverse relaxation times of ATP in human brain in vivo

31P MRS examinations of the brain of 10 healthy volunteers were performed to determine T2 of the coupled ATP signals by use of the localized 90 degrees-TE/2-2662-TE/2-acq frequency selective spin echo sequence for elimination of phase and intensity distortions. The T2 relaxation times obtained are much longer than usually assumed: gamma-ATP: 89 +/- 9 ms; alpha-ATP: 84 +/- 6 ms; beta-ATP: 62 +/- 3 ms.

Phosphorus J coupling constants of ATP in human myocardium and calf muscle

Proton-decoupled 31P NMR spectroscopy of the heart and calf muscle of healthy volunteers was performed with a 1.5 T whole-body imager. By use of two-dimensional chemical-shift imaging in combination with slice-selective excitation, well-resolved localized spectra (elements of 38 ml) were obtained within 20 to 35 min from which the homonuclear J coupling constants of ATP could be determined. In myocardium, J gamma beta = 16.03 +/- 0.17 Hz and J alpha beta = 15.82 +/- 0.23 Hz were obtained, while the values in calf muscle were J gamma beta = 17.16 +/- 0.12 Hz and J alpha beta = 16.04 +/- 0.09 Hz. The difference in J gamma beta was significant. According to the literature, a possible reason for greater ATP J coupling constants is a smaller fraction of ATP complexed to magnesium. However, the chemical-shift difference between alpha- and beta-ATP, which is also a measure for the fraction of ATP complexed to magnesium, showed only a small difference in ATP complexation: 88% in myocardium and 90% in calf muscle. This small difference cannot account for the observed difference in J gamma beta.

A pitfall associated with determination of transverse relaxation times of the 31P NMR signals of ATP using the Hahn spin-echo

T2 measurements of 31P NMR signals of ATP using the Hahn 90 degrees-180 degrees spin-echo sequence imply difficulties whenever the 180 degrees pulse angle is not completely perfect. The reason for this finding is the crucial influence of the J-couplings of the ATP signals which result in intensity modulations and consequently in false T2 values even when the echo times are chosen to TE = n/J. Examinations on the calf muscles of healthy volunteers were performed to demonstrate this effect and its influence on in vivo T2 determinations. The T2 relaxation times evaluated with the Hahn spin-echo in combination with a Helmholtz coil are far shorter than the true T2 values.

Phosphorus J-coupling constants of ATP in human brain

Proton decoupled 31P NMR spectroscopy of the occipital brain of healthy volunteers was performed with a 1.5 T whole-body imager. By use of two-dimensional chemical-shift imaging in combination with slice-selective excitation well resolved localized spectra (38 ml) were obtained within 34 min from which the homonuclear 31P-31P J-coupling constants of ATP could be determined: J(gammabeta) = 16.1 Hz +/- 0.2 Hz and J(alphabeta) = 16.3 Hz +/- 0.1 Hz (mean +/- SEM, n = 14). Both, the J-coupling constants and the chemical-shift difference between alpha- and beta-ATP (delta(alphabeta) = 8.61 ppm +/- 0.01 ppm) were used to calculate the concentration of intracellular free magnesium. The concentrations are 0.39 mM +/- 0.09 mM by using the average of both coupling constants of each spectrum, which is in fair agreement with 0.32 mM +/- 0.01 mM obtained from the chemical shift of alpha and beta phosphate resonances, which is the more accurate result.

Facile fabrication of robust superhydrophobic surfaces: comparative investigation

Comparison of eight simple but robust superhydrophobic coatings in a wide space of parameters, helpful for planning correct experiments.

Artifacts in CSI-measurements caused by the drift of the static magnetic field

In chemical shift resolved spectroscopic imaging (CSI) temporal changes in the static magnetic field (drift) can lead to distortions of the phase encoding process. This can result in localization artifacts. The extent of the artifact depends on the size of the drift, the number of acquisitions, as well as on the combination of the size of the field of view and the number of phase encoding gradient steps. Furthermore, it is affected by the succession of the phase encoding gradients. Precautions are described which allow substantial minimization of the artifact.

MRI and determination of T1 and T2 of solid polymers using a 1.5 T whole-body imager

Spin-echo sequences with echo times as short as 3.5 msec were implemented on a standard 1.5 T NMR whole-body imager for 1H imaging of polymers in the solid-state. No modification of the NMR hardware designed for clinical usage was made. Beside images of different polymers a "self-portrait" of the polymeric materials of the receiver coil is given as a neat application. Based on imaging experiments the longitudinal and transverse relaxation time of polymers were investigated. The results indicate that using a standard whole-body imager, it is possible to provide additional information to other examination techniques in polymer and materials science.

31P NMR studies of human soleus and gastrocnemius show differences in the J gamma beta coupling constant of ATP and in intracellular free magnesium

Localized proton decoupled 31P in vivo NMR spectroscopy of the human calf muscle was performed using a 1.5-T whole-body imager and the slice selective two-dimensional chemical-shift-imaging (2D-CSI) technique. The 31P-31P coupling constants and the chemical shifts of ATP were compared in gastrocnemius and soleus. Significant differences were found in the coupling constant J gamma beta: (18.1 +/- 0.7) Hz versus (17.1 +/- 0.6) Hz (means +/- SD, P < 10-5). Differences were also observed in the chemical shift separation delta alpha beta between the alpha- and beta-ATP signal: (8.498 +/- 0.023) ppm versus (8.522 +/- 0.222) ppm (p < 0.001) in gastrocnemius and soleus, respectively. A higher [MgATP]/[ATPfree] ratio and a significantly higher level of intracellular free magnesium of (0.52 +/- 0.06) mM in gastrocnemius versus (0.46 +/- 0.05) mM in soleus (p < 0.001) can be derived based on delta alpha beta and KDMgATP. Heterogeneity needs to be taken into account in clinical studies on magnesium by NMR methods in calf muscle. The coupling constant J gamma beta provides additional information, possibly on enzymatic processes, and correlates with [Mg2+free]. The detailed analysis of muscles with different fiber type characteristics lends support to the significance of this parameter in evaluating metabolism. The data reported can be used as prior knowledge for fits in which the coupling constants are set to a fixed value.

Detection of phosphomonoester signals in proton-decoupled 31P NMR spectra of the myocardium of patients with myocardial hypertrophy

Proton-decoupled 31P NMR spectroscopy at 1.5 T of the anterior left ventricular myocardium was used to monitor myocardial phosphate metabolism in asymptomatic patients with hypertrophic cardiomyopathy (HCM, n = 14) and aortic stenosis (AS, n = 12). In addition to the well-known phosphorus signals a phosphomonoester (PME) signal was detected at about 6.9 ppm in 7 HCM and 2 AS patients. This signal was not observed in the spectra of normal controls (n = 11). We suggest that in spectra of patients with myocardial hypertrophy the presence of a PME signal reflects alterations in myocardial glucose metabolism.

31P/1H WALTZ-4 broadband decoupling at 1.5 T: different versions of the composite pulse and consequences when using a surface coil

Two derivatives of the wideband alternating-phase low-power technique for zero-residual splitting (WALTZ)-4 decoupling sequence for broadband decoupling named WALTZ-4a and WALTZ-4b were compared for their proton decoupling performance in 31P nuclear magnetic resonance (NMR) spectroscopy using a Siemens Magnetom SP 1.5 T whole-body imager. Version WALTZ-4a originally implemented by the manufacturer doubles and triples the transmitter amplitude of the 90 degrees pulse to achieve the 180 degrees and 270 degrees flip angle required for one composite pulse R in the WALTZ sequence. WALTZ-4b follows the sequence reported from Shaka et al. and leaves the transmitter amplitude constant but increases the durations of the 180 degrees and 270 degrees pulses. The decoupling performance of WALTZ-4b is superior because it requires less transmitter power and, therefore, it is advantageous in all in vivo studies where a low specific absorption rate is desired. When WALTZ-4 is used in combination with a surface coil for transmission the theoretically required flip angles cannot be achieved in the entire sensitive volume of the coil. The decoupling performance was therefore investigated at lower and higher flip angles. Again, WALTZ-4b is advantageous and provides, in certain ranges that are off-resonant from the decoupling frequency, a good decoupling quality even for flip angles that are only 60% of the theoretically required.

Imaging of the human cardiovascular system using the rapid echo flow-rephased spin-echo technique

Using a flow-rephased spin-echo technique with a short echo time of TE = 9.7 msec, "white blood" multislice and single slice first echo images of the human heart were acquired using standard 1.5 T whole-body imagers. The technique almost completely eliminates phase shifts for flow with constant velocity and constant acceleration, so the investigations with healthy volunteers show images which are almost free of the artifacts often found in ECG-gated standard spin-echo imaging of the heart. T1-weighted images with good contrast between tissue and blood are achieved at any time during the whole heart cycle. The results obtained indicate that the technique might be helpful for imaging small vessels, vessels which contain slowly flowing blood, and vessels located in regions with static field inhomogeneities, for example, lung vessels.

Change in chemical shift and splitting of 31P gamma-ATP signal in human skeletal muscle during exercise and recovery

Proton decoupled 31P in vivo NMR spectroscopy of the human finger flexor muscles was performed during exercise and recovery using a 1.5 T whole-body imager. Predominantly the gamma-ATP signal shows a splitting caused by different signal contributions with chemical shifts that vary independently. Studies on the human gastrocnemius and biceps femoris muscle were undertaken to investigate the appearance of the splitting in these muscles as well. In all cases more than one signal contribution was found which might represent the different muscle fibre types and their recruitment pattern following exercise. An analysis of the chemical shifts (delta) of ATP results in changes of up to 0.4 ppm and 0.1 ppm for delta gamma- and delta beta-ATP, respectively. Based solely on the chemical shifts of the ATP 31P signals the tissue pH value following exercise was determined. The result was in good agreement with the value derived from delta Pi.

Potential pitfall in the determination of free [Mg2+] by 31P NMR when using the beta/alpha-ATP peak height ratio method

Recently, Clarke et al. (Clarke K, Kashiwaya Y, King MT, Gates D, Keon CA, Cross HR, Radda GK, Veech RL. The beta/alpha peak height ratio of ATP. A measure of free [Mg2+(free)] using 31P NMR, J. Biol. Chem. 1996;271:21142 21150.) reported a new method to noninvasively determine the concentration of intracellular free magnesium ([Mg2+(free)]) based on the measurement of the peak height ratio h(beta/alpha) of the beta- and alpha-ATP signals in 31P NMR spectra. h(beta/alpha) varies with [Mg2+(free)], however, the study presented here shows that h(beta/alpha) also strongly depends on the homogeneity of the static magnetic field. For this reason, we performed at a magnetic field strength of 1.5 T 31P NMR measurements of solutions that mimic intracellular medium. The magnetic field homogeneity was varied by changing the currents in the shim coils, and the effect on hbeta/alpha is demonstrated with and without proton decoupling. In both cases, h(beta/alpha) strongly depends on the magnetic field homogeneity and can therefore lead to a pitfall in the determination of [Mg2+(free)].